Over the past two days, I have covered smallpox and anthrax. I would now like to cover the rest of Category A.
There are a total of six categories and twelve total biological maladies which are listed as Category A bioterror threats, according to the CDC. Anthrax and Smallpox make up two of them. The others can be split into four categories:
- Bubonic Plague
- Rabbit Fever
- Viruses (Ebola, Lassa, etc.)
I shall, once again, incorporate some of Professor Bhakdi’s arguments as the basis of why I believe that there are no major bioterror threats, going one by one.
The stuff that rich, old people inject into their foreheads to make them look more like wax dummies than wrinkled dummies also functions as a poison. Botulism works by getting into the gastro-intestinal system, and then taking a ride down the bloodstream and into the muscular nerves. So basically, you have to eat botulism-poisoned food. It can be a very dangerous substance, and recovery could take weeks to months. However, because you must ingest it, it makes for a pitiful weapon for a terrorist attack. Botulism cannot be spread from person to person, it could not possibly be released in aerosol form into a crowd, and even if an attack worked perfectly, there is no way that the casualty rate could be higher than a few dozen cases with perhaps a few deaths. In short, this is not a viable weapon for sowing terror—the threat vector is just far too limited.
Positives for terrorists: deadly; recovery takes a long time; fairly low chance of detection
Negatives for terrorists: pitiful infection rate; limited use
Now we’re talking: wipe out a third of Europe, kill millions, spread like crazy. It even sounds scary: “You have…the plague.” Yeah, this is a weapon to use. And I’m sure that there are terrorists who are giddy about the idea. But let’s think about threat vectors once again.
How did the plague spread through Europe, wiping out a third of the population in the 1300s? Through rats. Rats with fleas on them. The fleas carry the plague, and when they burrow into human flesh, they deposit the plague. Bubonic plague cannot spread through airborne means. A small percentage would develop pneumonic plague, which can be spread through respiratory droplets.
So we have two channels of attack:
Bubonic plague – Plague-infected fleas, carried by animals such as rats, spreading the disease to humans. This can not be transmitted between humans.
Pneumonic plague – Breathing in plague bacteria which have been suspended in respiratory droplets. This can be transmitted between humans.
So, for the bubonic plague aspect, the terrorist attack would be to release a bunch of plague-filled rats and have them do their work, whereas for pneumonic plague, the aerosol route is by far the most tempting. Now, what are the issues? With bubonic plague, the issue of transmittal is that it already exists. There are animals in the United States which have plague-infected fleas on them. These animals can get people sick. As for pneumonic plague, it might be possible, though there will be the technical issues of keeping the nozzle of an aerosol attack clean. Furthermore, the plague bacteria has a natural enemy: sunlight. Do it during a sunny day and the bacteria die very quickly. The CDC site states that bacteria will survive up to one hour. This does not make for a very good threat. In addition, there would be the fact that you would still want to manufacture a potent version, which brings us back to the old problem of R&D funding and scientists who know what they’re doing. This makes the threat potency kind of murky.
But on top of this, there is a huge, huge problem for terrorists who want to attack the US in such a way: there are measures in place to handle plague instances. Roughly 5-15 cases occur in the United States each year, and most rural areas have health departments which keep an eye on and handle any breakouts of plague cases. Furthermore, the plague can be treated with antibiotics, so even in the terrorist nightmare scenario—tens of thousands of people getting infected by aerosol-based plague-carrying droplets—it is very likely that only a few people would die. Again, this is hundreds of millions to billions of dollars in research, development, training, testing, planning, and carrying out a plan versus a couple of deaths. So we can wipe out either form of the plague as a serious threat.
Rabbit fever, otherwise known as tularemia, is a bacterial disease found in rodents, rabbits, and hares. The primary infection method is through ticks or fleas which carry the disease, or by handling diseased animals. Roughly 200 cases occur in humans each year in the US. The terrorist preferred method would be to use it as an airborne bacteria to attempt to spread it. It is easy to get rabbit fever in terms of the number of bacteria which would need to be ingested, though it cannot be passed on from human to human.
As I said, aerosol techniques would potentially work…but, as the CDC points out, “manufacturing an effective aerosol weapon would require considerable sophistication.” So again, we’re talking big lab, smart guys in white coats, and lots of funding. This is an immediate strike against. But the death blow against rabbit fever is that it’s extremely easy to treat. Infect thousands of people and chances are that the returns will be even lower than for the plague. So rabbit fever is out as a legitimate terrorist option, as the costs would far outweigh the benefits.
The first time I thought seriously about bioterrorism was due to one of Tom Clancy’s novels. In this book (and forgive me if I mess up the plot any; it has been roughly 6 or 7 years since I’ve read the book), a state-sponsored terrorist organization harvests monkey kidneys infected with Ebola. They then find a way to put this into aerosol form and attack several major US sites simultaneously. So this category is of particular interest to me, especially because viruses cannot be treated with antibiotics, which makes them potentially more dangerous than bacteria such as anthrax, rabbit fever, or botulism. So let’s dive right into it.
The particular category of viruses that the CDC classifies as Category A is Viral Hemorraghic Fevers. Probably the most dangerous ones for our purposes are Ebola, Marburg, Lassa, and Crimean-Congo, due to the fact that they can spread from person to person and do not have vaccines in place to prevent (such as yellow fever). These could conceivably be put into aerosol form and used in an attack.
But again, we have the same problems with aerosols as before. The equipment, facilities, research, and scientist training costs are very, very expensive. The costs for these viruses would probably be even greater than for the bacteria, due to the fact that it is extremely difficult to breed these viruses. Take a look at the known cases for Marburg and Ebola and notice something: just how few outbreaks there are. For Marburg, there are just six known outbreaks, with one of them occurring in laboratory situations. As for Ebola, there are 23 listed cases. You can also scratch off 8 of those as not really outbreaks. One case was accidental infection, one was a person who was treating an outbreak, and 6 were introductions into quarantine facilities. So we have 20 outbreaks of these two viruses in a period of roughly 40 years. This might be an indication of how difficult it is to develop Ebola, as it would seem that relatively few animals carry the diseases. So that is problem one. Problem two is that it is difficult to spread these viruses. Note, again, the descriptions on the CDC site for Marburg and Ebola. I will break out the major cause of spread in the 20 outbreaks and note which ones are serious in a situation like the United States by bolding them.
- Infection spreading to nurse and companion
- Doctor attempts resuscitation
- Working at a gold mine, and village-to-village spread; my conjecture is that a sick person continued working and contaminated others for each.
- Close personal contact with the infected
- Using contaminated needles
- Infected chimpanzee eaten for food, and family members of those who ate the monkey
- Attending funerals of disease-infected individuals
- Providing medical care without appropriate personal measures
So as we can see, some of these reasons could happen in the US, but others are outlandish and are indicative of the terrible medical quality in Africa. It also forces me to ask this question: how well could these viruses spread without the assistance of poor medical care? In a country like the US, hospitals will not use contaminated needles, the bodies of Ebola victims would be burned, doctors take appropriate measures to avoid infection (and would be even more vigilant if an outbreak were known), and the chance of eating Ebola-infected monkeys is rather low. Really, the only threat is that of spreading the disease during the post-incubation period but before becoming sick enough to go to the hospital. So, similar to smallpox, we would probably see a fair percentage of first-generation death (though nothing like the 90% that those African cases showed, and probably closer to 33% of those who actually develop the diseases in a regime of good health care, as one finds in the West) and a few stragglers in the second and third generations. I would imagine that an epidemic would quickly fizzle once it became known that there was an outbreak of Ebola or Marburg or something similar, as people would then take appropriate precautions.
There is one additional reason which Professor Bhakdi uses to argue that viruses are not a legitimate threat: an infectious disease like Ebola or Marburg is, well, infectious. Your everyday Joe Terrorist has neither the equipment nor the expertise to handle Ebola-infected animals and is likely to infect himself on accident. The thought of this would likely turn potential users off from viruses and over to something safer. After all, even those who want to become martyrs have an idea of what happens when you get infected, and they would likely have hospital conditions at least as bad as those in Africa, so in fact, it is more likely that terrorists would infect their local population (due to terrible hospital standards) rather than infect Americans.
So here is the breakdown, just like last time:
Risk – Very Low. None of these is likely to be used in an attack, and the ones which might be used have easy cures. The viruses which have no cure are also extremely unlikely to be used, due in part to the fact that the terrorists have a better chance of infecting themselves than any Westerner.
Retaliation Against Foreign Government Factor – Low to Medium. These attacks would require considerable resources, which implies likely state funding. If an attack were pulled off and could be traced back to a government, the American response could be a nuclear retaliation and would likely involve deposing the government. However, none of these really ties to a particular government like smallpox does, so it might be possible for a government to fund and direct an attack without being caught.
Likelihood of Failure – Very High. Biological warfare isn’t something for amateurs, and even the scientists who work for terrorist organizations are relatively amateur. Not too many guys at the CDC or Pasteur Institute work for Hezbollah, after all, and even if some did, they still need the equipment, and would need to solve the aerosol problem. Then there is the fact that most of these are treatable, so in the end, the chances of pulling off a major success and killing hundreds approaches zero.
Media Factor – Medium-Low to High (viruses). If the attack is rabbit fever, the media story basically boils down to “Hey, this is kind of like what this farmer over here got on accident. Let’s have 30 stories in which this guy talks about the shots he got over at the local hospital…and then drop it because this is boring.” Botulism would take up a series of tips normally dedicated to salmonella. Bubonic plague’s story line would be “Yes, it killed a third of Europe, but now we have hospitals and antibiotics. Hey, did you hear the latest news about Britney Spears?” The only one which would really command attention is the release of a virus, and even that would die out pretty soon, once the first wave ended.
Summary of All Category A Biological Agents
I have gone through each of the Category A biological threats, and each one comes up as wanting. They are far more expensive to produce than you hear in media reports, they pose huge logistical problems, and they more or less don’t work. Taking a look at the MIPT Terrorism Knowledge Database, let’s note how many biological attacks have been used in various western countries. Taking a look at this link, there are 13 total entries. 9 of them cover the same anthrax attack that I described yesterday. Here are the other four:
- A letter with anthrax is discovered in Venezuela. Nobody becomes infected.
- A letter with a “suspicious powder” is discovered in Brazil. The person opening the letter is treated for an allergic reaction, meaning that this was not anthrax. No other results.
- A letter with anthrax is sent to a newspaper in Pakistan. This tests positive for anthrax. No infections.
- A man is assassinated with a toxin in Kashmir. This would not have been a Category A attack, and thus is basically as dangerous as shooting the man.
So in the 38 years since terrorism has taken off as a major affair, we’ve had 3 real biological attacks, and one thing which seems like a hoax that just accidentally caused an allergic reaction. The end result is that 5 people died. In short, if biological weapons were as potent, deadly, and inexpensive as media reports suggest, you would think that more people would have used them by now. My goal in this three-part series was to describe the most dangerous forms of bioterrorism and how much of a threat they are. In the end, I do not see them as a viable threat for terrorists. Now, this does not mean that absolutely no resources should be used in regard to these diseases, or that you should walk around opening up powder-laced packages, but it does mean that people should not really fear that such things would be used in a terrorist attack, as it is far too impractical.